<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Documento sin t&iacute;tulo</title>
</head>

<body>
<table width="80%" border="1" align="center">
  <tr>
    <td>&lt;similar superior pws&gt;</td>
  </tr>
  <tr>
    <td><div align="center">Ingrese Datos Otra Patente  </div></td>
  </tr>
  <tr>
    <td><table width="60%" border="0" align="center">
      <tr>
        <td><table width="200" border="0" cellpadding="0" cellspacing="0">
          <tr>
            <td>Rut</td>
            <td>:</td>
            <td>99999999-9</td>
          </tr>
          <tr>
            <td>Nombre</td>
            <td>:</td>
            <td>XXXXXXXXXXXXX</td>
          </tr>
          <tr>
            <td>eMail</td>
            <td>:</td>
            <td>skjdhskjdf@skjdb.cl</td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><table width="80%" border="1" align="left" cellpadding="0" cellspacing="0">
          <tr>
            <td colspan="2">Seguro Automotriz que tendr&aacute; SOAP Gratis </td>
            </tr>
          <tr>
            <td width="24%">Patente</td>
            <td width="76%"><input type="text" name="textfield" /></td>
          </tr>
          <tr>
            <td>Tipo Vehiculo </td>
            <td><select name="select">
              <option value="1">Automovil</option>
            </select>
            </td>
          </tr>
          <tr>
            <td>Marca</td>
            <td><select name="select2">
              <option value="1">Hyundai</option>
            </select>
            </td>
          </tr>
          <tr>
            <td>Modelo</td>
            <td><select name="select3">
              <option value="1">Accent</option>
            </select>
            </td>
          </tr>
          <tr>
            <td>A&ntilde;o</td>
            <td><input type="text" name="textfield2" /></td>
          </tr>
          
          <tr>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><table width="100%" border="1" align="center">
          <tr>
            <td><div align="center">
              <input type="submit" name="Submit" value="Volver" onclick="javscript:location.href='listadoseguros.html'"/>
            </div></td>
            <td>&nbsp;</td>
            <td><div align="center">
              <input type="submit" name="Submit2" value="Aceptar" onclick="javscript:location.href='confirmacion.html'"/>
            </div></td>
          </tr>
        </table></td>
      </tr>
    </table></td>
  </tr>
</table>
</body>
</html>
